Organization
PRIME HEALTH SYSTEM ,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIELA MAATOUK (ADMINISTRATOR)
(847) 730-7098
Entity
Organization
Contact information
Practice address
1030 N CLARK ST STE 647, CHICAGO, IL 60610-5469
(847) 810-9095
Mailing address
1030 N CLARK ST STE 647, CHICAGO, IL 60610-5469
Taxonomy
Speciality
Code
Description
License number
State
202D00000X
Integrative Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036086819
MEDICAL LICENSE
IL
Enumeration date
05/02/2022
Last updated
05/02/2022
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